title: Quantitative analysis of tympanic membrane perforation: a simple and reliable method.
abstract: BACKGROUND
  Accurate assessment of the features of tympanic membrane perforation, especially size, site, duration and aetiology, is important, as it enables optimum management.
  
  
  OBJECTIVE
  To describe a simple, cheap and effective method of quantitatively analysing tympanic membrane perforations.
  
  
  METHODS
  The system described comprises a video-otoscope (capable of generating still and video images of the tympanic membrane), adapted via a universal serial bus box to a computer screen, with images analysed using the Image J geometrical analysis software package. The reproducibility of results and their correlation with conventional otoscopic methods of estimation were tested statistically with the paired t-test and correlational tests, using the Statistical Package for the Social Sciences version 11 software.
  
  
  RESULTS
  The following equation was generated: P/T x 100 per cent = percentage perforation, where P is the area (in pixels2) of the tympanic membrane perforation and T is the total area (in pixels2) for the entire tympanic membrane (including the perforation). Illustrations are shown. Comparison of blinded data on tympanic membrane perforation area obtained independently from assessments by two trained otologists, of comparative years of experience, using the video-otoscopy system described, showed similar findings, with strong correlations devoid of inter-observer error (p = 0.000, r = 1). Comparison with conventional otoscopic assessment also indicated significant correlation, comparing results for two trained otologists, but some inter-observer variation was present (p = 0.000, r = 0.896). Correlation between the two methods for each of the otologists was also highly significant (p = 0.000).
  
  
  CONCLUSIONS
  A computer-adapted video-otoscope, with images analysed by Image J software, represents a cheap, reliable, technology-driven, clinical method of quantitative analysis of tympanic membrane perforations and injuries.
authors.affiliation: Department of Surgery, Division of ENT, Irrua Specialist Teaching Hospital, College of Medicine, Ambrose Alli University, Ekpoma, Nigeria.
authors.forename: T S
authors.initials: TS
authors.lastname: Ibekwe
authors.forename: A A
authors.initials: AA
authors.lastname: Adeosun
authors.forename: O G
authors.initials: OG
authors.lastname: Nwaorgu
mesh_terms: D000465:Algorithms; D003936:Diagnosis, Computer-Assisted; D006801:Humans; D015588:Observer Variation; D038781:Otoscopy / Q000379:methods*; D016037:Single-Blind Method; D018058:Tympanic Membrane Perforation / Q000473:pathology*